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recommendations
on shorter
MDR-TB regimen
Fuad Mirzayev
WHO Global TB Programme
CNS webinar, 11 July 2016
2|
GRADE evaluation
*Grades of Recommendation Assessment, Development and Evaluation
Clear separation:
Recommendation
strong or conditional/optional/weak (for or
against an intervention)
Benefits and downsides, values and
preferences, impact, resource use
balanced with
Quality of evidence
Quality of
evidence
Patient
values &
preferences
Balance
between
benefits, harms
& burdens
Resource
use
Certainty of evidence
Certainty
High
Moderate
Low
Very low
Definition
Further research is very unlikely to change our
confidence in the estimate of effect.
Further research is likely to have an important impact
on our confidence in the effect and may change the
estimate.
Further research is very likely to have an important
impact on our confidence in the estimate of effect
and is likely to change the estimate.
Any estimate of effect is very uncertain.
Adapted from Guyatt GH et al. BMJ. 2008 Apr 26,336(7650):924-6
www.who.int/tb/challenges/mdr/short_regimen_use/en/
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever
on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its
authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent
approximate border lines for which there may not yet be full agreement. WHO 2012. All rights reserved.
Bangladesh
Benin
Burkina Faso
Burundi
Cameroon
Central African
Republic
Cte dIvoire
DR Congo
Guinea
Niger
Rwanda
Senegal
Swaziland
Uzbekistan
Confirmed resistance or suspected ineffectiveness to a medicine in the shorter MDRTB regimen (except isoniazid resistance)
Exposure to >1 second-line medicines in the shorter MDR-TB regimen for >1 month
Intolerance to >1 medicines in the shorter MDR-TB regimen or risk of toxicity (e.g.
drug-drug interactions)
Pregnancy
Extrapulmonary disease
YES
NO
Shorter MDR-TB
regimen
Individualized
(conventional)
MDR-TB regimens
THANK YOU!